儿科院内心脏骤停：与一年后存活和神经行为预后相关的因素。
Paediatric in-hospital cardiac arrest: Factors associated with survival and neurobehavioural outcome one year later.
机构信息
Children's Hospital of Michigan, Wayne State University, 3901 Beaubien Boulevard, Detroit, MI, 48201, USA.
University of Utah, 295 Chipeta Way, P. O. Box 581289, Salt Lake City, UT, 84158, USA.
出版信息
Resuscitation. 2018 Mar;124:96-105. doi: 10.1016/j.resuscitation.2018.01.013. Epub 2018 Jan 6.
OBJECTIVE
To investigate clinical characteristics associated with 12-month survival and neurobehavioural function among children recruited to the Therapeutic Hypothermia after Paediatric Cardiac Arrest In-Hospital trial.
METHODS
Children (n = 329) with in-hospital cardiac arrest who received chest compressions for ≥2 min, were comatose, and required mechanical ventilation after return of circulation were included. Neurobehavioural function was assessed using the Vineland Adaptive Behaviour Scales, second edition (VABS-II) at baseline (reflecting pre-arrest status) and 12 months post-arrest. Norms for VABS-II are 100 (mean) ±15 (SD). Higher scores indicate better functioning. Outcomes included 12-month survival, 12-month survival with VABS-II decreased by ≤15 points from baseline, and 12-month survival with VABS-II ≥70.
RESULTS
Asystole as the initial arrest rhythm, administration of >4 adrenaline doses, and higher post-arrest blood lactate concentration were independently associated with lower 12-month survival; an adrenaline dosing interval of 3-<5 min and open chest compressions were independently associated with greater 12-month survival. Use of extracorporeal membrane oxygenation (ECMO) and higher blood lactate were independently associated with lower 12-month survival with VABS-II decreased by ≤15 points from baseline; open chest compressions was independently associated with greater 12-month survival with VABS-II decreased by ≤15 points. Asystole as the initial rhythm, use of ECMO, and higher blood lactate were independently associated with lower 12-month survival with VABS-II ≥70; open chest compressions was independently associated with greater 12-month survival with VABS-II ≥70.
CONCLUSIONS
Cardiac arrest and resuscitation factors are associated with long-term survival and neurobehavioural function among children who are comatose after in-hospital arrest.
目的
调查 Therapeutic Hypothermia after Paediatric Cardiac Arrest In-Hospital 试验中入组的患儿 12 个月生存率和神经行为功能与哪些临床特征相关。
方法
纳入院内心脏骤停、接受≥2 min 胸外按压、意识昏迷且循环恢复后需要机械通气的患儿（n=329）。神经行为功能采用儿童适应行为评定量表第二版（Vineland Adaptive Behaviour Scales, second edition, VABS-II）进行评估，基线时（反映发病前状态）和发病后 12 个月时各评估一次。VABS-II 的正常范围为 100（均值）±15（标准差）。得分越高表明功能越好。结局包括 12 个月生存率、基线时 VABS-II 评分下降≥15 分的 12 个月生存率以及 VABS-II≥70 的 12 个月生存率。
结果
初始停搏节律为心搏停止、使用肾上腺素剂量>4 次、以及较高的复苏后血乳酸浓度与较低的 12 个月生存率独立相关；肾上腺素给药间隔为 3-<5 min 和开胸按压与较高的 12 个月生存率独立相关。使用体外膜肺氧合（extracorporeal membrane oxygenation, ECMO）和较高的血乳酸与基线时 VABS-II 评分下降≥15 分的 12 个月生存率较低独立相关；开胸按压与基线时 VABS-II 评分下降≥15 分的 12 个月生存率较高独立相关。初始节律为心搏停止、使用 ECMO 和较高的血乳酸与 VABS-II≥70 的 12 个月生存率较低独立相关；开胸按压与 VABS-II≥70 的 12 个月生存率较高独立相关。
结论
心脏骤停和复苏因素与院内心脏骤停后昏迷患儿的长期生存率和神经行为功能相关。
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